OBJECTIVE: Intracranial artery stenosis can be fatal, requiring fast, safe and effective intervention. The introduction of the Wingspan™ stent system with Gateway™ percutaneous transluminal angioplasty balloon catheter has made intracranial intervention possible in a clinical trial setting. This systematic review planned to identify and review all randomized controlled trials comparing angioplasty and stenting of intracranial arteries with standard medical care. METHODS: Electronic databases and relevant records were examined for possible trials using predefined inclusion and exclusion criteria. RESULTS: A total of 3661 records were identified by searching several English language databases and other sources including Chinese academic journals. The recently discontinued Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was the single qualifying study and showed clear advantage of medical management over percutaneous transluminal angioplasty and stenting (PTAS). CONCLUSIONS: The SAMPRASS trial indicated that PTAS is associated with high complication and morbidity rates. Definitive recommendations cannot be made until convincing results from additional robustly designed randomized trials become available.
FeldmannEDaneaultNKwanE: Chinese—white differences in the distribution of occlusive cerebrovascular disease. Neurology1990; 40: 1541–1545.
2.
QureshiAIFeldmannEGomezCR: Intracranial atherosclerotic disease: an update. Ann Neurol2009; 66: 730–738.
3.
WhiteHBoden-AlbalaBWangC: Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation2005; 111: 1327–1331.
4.
WongKSLiHChanYL: Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke2000; 31: 2641–2647.
5.
ChimowitzMILynnMJSmithH Howlett: Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med2005; 352: 1305–1316.
6.
QureshiAIHusseinHMEl GengaihyA: Concurrent comparison of outcomes of primary angioplasty and of stent placement in high-risk patients with symptomatic intracranial stenosis. Neurosurgery2008; 62: 1053–1060.
7.
FiorellaDChowMMAndersonM: A 7-year experience with balloon-mounted coronary stents for the treatment of symptomatic vertebrobasilar intracranial atheromatous disease. Neurosurgery2007; 61: 236–243.
8.
BoseAHartmannMHenkesH: A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke2007; 38: 1531–1537.
9.
FiorellaDLevyEITurkAS: US multicenter experience with the Wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke2007; 38: 881–887.
10.
EberhardtONaegeleTRaygrotzkiS: Stenting of vertebrobasilar arteries in symptomatic atherosclerotic disease and acute occlusion: case series and review of the literature. J Vasc Surg2006; 43: 1145–1154.
LevyEIHorowitzMBKoebbeCJ: Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: early results. Neurosurgery2001; 48: 1215–1221.
13.
BrooksWHMcClureRRJonesMR: Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol2001; 38: 1589–1595.
14.
CARESS Steering Committee: Carotid revascularization using endarterectomy or stenting systems (CARESS): phase I clinical trial. J Endovasc Ther2003; 10: 1021–1030.
15.
Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): A randomised trial. Lancet2001; 357: 1729–1737.
16.
BrottTGHobsonRW2ndHowardG: Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med2010; 363: 11–23.
17.
MasJLChatellierGBeyssenB: Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med2006; 355: 1660–1671.
18.
MazighiMTanasescuRDucrocqX: Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology2006; 66: 1187–1191.
19.
BonatiLHJongenLMHallerS: New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: A substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol2010; 9: 353–362.
20.
LiuCWLiuBYeW: Carotid endarterectomy versus carotid stenting: A prospective randomized trial. Zhonghua Wai Ke Za Zhi2009; 47: 267–270 [in Chinese, English abstract].
McKevittFMSivaguruAVenablesGS: Effect of treatment of carotid artery stenosis on blood pressure: A comparison of hemodynamic disturbances after carotid endarterectomy and endovascular treatment. Stroke2003; 34: 2576–2581.
23.
MacdonaldSEvansDHGriffithsPD: Filter-protected versus unprotected carotid artery stenting: A randomised trial. Cerebrovasc Dis2010; 29: 282–289.
24.
NaylorARBoliaAAbbottRJ: Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: A stopped trial. J Vasc Surg1998; 28: 326–334.
25.
QureshiAI: Endovascular treatment of cerebrovascular diseases and intracranial neoplasms. Lancet2004; 363: 804–813.
26.
StolkerJMMahoneyEMSafleyDM: Health-related quality of life following carotid stenting versus endarterectomy: results from the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) trial. JACC Cardiovasc Interv2010; 3: 515–523.
27.
SooYOMakHAbrigoJ: Chronic hypoperfusion is common and reversible in moderate to severe larger artery atherosclerosis. Cerebrovasc Dis2010; 29: 108 [abstract].
28.
RinglebPAHackeW: Stent and surgery for symptomatic carotid stenosis. SPACE study results. Nervenarzt2007; 78: 1130–1137 [in German, English abstract].
29.
SteinbauerMGPfisterKGreindlM: Alert for increased long-term follow-up after carotid artery stenting: results of a prospective, randomized, single-center trial of carotid artery stenting vs carotid endarterectomy. J Vasc Surg2008; 48: 93–98.
30.
LingFJiaoLQ: Preliminary report of trial of endarterectomy versus stenting for the treatment of carotid atherosclerotic stenosis in China (TESCAS-C). Chin J Cerebrovasc Dis2006; 1: 4–8.
31.
WittKBörschKDanielsC: Neuropsychological consequences of endarterectomy and endovascular angioplasty with stent placement for treatment of symptomatic carotid stenosis: A prospective randomised study. J Neurol2007; 254: 1524–1532.
32.
BrooksWHMcClureRRJonesMR: Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: A randomized trial in a community hospital. Neurosurgery2004; 54: 318–324.
33.
ChimowitzMILynnMJDerdeynCP: Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med2011; 365: 993–1003.
34.
CompterAvan der WorpHBSchonewilleWJ: VAST: Vertebral Artery Stenting Trial. Protocol for a randomised safety and feasibility trial. Trials2008; 9: 65.
35.
Prognosis of patients with symptomatic vertebral or basilar artery stenosis. The Warfarin—Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Stroke1998; 29: 1389–1392.
36.
KasnerSELynnMJChimowitzMI: Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID. Neurology2006; 67: 1275–1278.
37.
GröschelKSchnaudigelSPilgramSM: A systematic review on outcome after stenting for intracranial atherosclerosis. Stroke2009; 40: e340–e347.
BonatiLHEderleJMcCabeDJ: Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol2009; 8: 908–917.
40.
Failure of extracranial—intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med1985; 313: 1191–1200.
